I have the Insurance info on the client and their plan does not cover 90847 sessions.
I was wondering about the rules or restrictions to having two people in a 90834/37 session. If they can only be there as a support person/translator, or if they can be active in the session?
With the 90847 you still established ONE patient on record correct? To bill the individual therapy codes, the patient of record would be the ONLY one who can participate in the session and the diagnosis has to support the therapy as individual. If this is for marriage counseling, problems in marriage in general, most likely they carrier is not going to cover it and using the individual therapy code would not be appropriate. When you said the insurance wouldn't cover the 90847 most likely they don't cover "marriage or family counseling" it's not the CPT that's not covered it's the supporting diagnosis with a patient. Now if one of the patient's has a diagnosis that could support an individual session it would be fine to bill that, it's even ok for the spouse to be IN the session but may not participate at all and you want your client to cover themselves with additional documentation in the file because it is highly inappropriate as a general rule of thumb for more than one person to be in an individual session.. once yes, twice would raise a flag. JMHO
Bottom line is that if traditionally the therapist wants to continue the way the record has been established that would be the appropriate coding (90847) and have the patient pay up front or bill them. I'd say to change the coding to get the insurance to pay would be asking for trouble.
About your other remark about the insurance company not knowing about the EAP: Where does this come from? I'd like to learn more about it (about everything really, since I'm still/always in a learning phase). My personal insurance (Premera Blue Cross) knows that I have EAP sessions and can tell me if they are used or not. I think the employer does not know if or why I have used them, but the insurance knows how many I used (probably not why though...).
An EAP is a privately purchased organization/service from the employer. It is not insurance, it's an extra confidential benefit. There is NO sharing of any information between an EAP and the Employer NOR is there any sharing of information or need to know between the EAP and the major medical benefit. The EAP will know of the Major Medical benefit to refer you to once EAP sessions are exhausted. The major medical carrier should not have any information on the EAP aside from possibly knowing one exists which is also really NOT appropriate. The reason is simple, there is to be no BIAS in claim determination based on EAP benefits. EAP will cover and pay benefits for any mental health illness, alcohol, substance abuse. If the major medical carrier knows about the EAP then there is a chance of a breach and bias. My major medical carrier could not tell you anything about our EAP or even if it exists or not since they would NOT NEED this information to process claims on our behalf. The insurance carrier should not be able to tell if the EAP was accessed if they know there is an EAP, it's NOT information they need and could result again in bias.